Has health reform become a taboo topic? In his State of the Union speech on Tuesday evening, President Obama referred to it only once. By one count, he devoted only 44 words to the subject. That's out of a total of over 7,000 for a meager 0.6 percent.

Obama leaves health reform out of the State of the Union address

President Barack Obama delivering his State of the Union address on Jan. 24, 2012. (Saul Loeb / AP / Pool)

Robert Field

In his State of the Union speech on Tuesday evening, President Obama referred to it only once. By one count, he devoted only 44 words to the subject. That’s out of a total of over 7,000 for a meager 0.6 percent. (Click here for a transcript of the entire speech.)

The president didn’t even mention health reform by name. He referred to it obliquely by promising not to go back to the days of policy cancellations, coverage denials, and differential premiums for men and women. He never stated that those days were ended by his reform law.

And he neglected to acknowledge Adam Rapp, a guest sitting next to First Lady Michelle Obama, whom White House officials had touted to the press as a health reform success story. He was able to maintain health coverage after a cancer diagnosis thanks to the law.

It was different in years past. Obama’s first State of the Union, which he delivered soon after taking office in 2009, included 427 words on health reform, or 7.2 percent of the total. In 2010, two months before the law was passed, he uttered 570 words on the subject representing 7.8 percent of his speech. And last year, the issue still garnered 224 words, or 3.2 percent of the talk (the subject of my blog post of January 28, 2011).

The Republican response wasn’t much different. Indiana Gov. Mitch Daniels’ speech included 1,840 words of which only seven touched on health reform. And, as in Obama’s talk, they did so indirectly. Governor Daniels accused the President of selling Americans short because “we might pick the wrong health insurance.” (Click here for a transcript of the entire response.)

Do the parties think we don’t care about health reform anymore? Perhaps jobs and the economy have pushed health care aside as a concern. In a recent USA Today/Gallup Poll, over 60 percent of respondents wanted Obama to focus on jobs in his speech while only 11 percent wanted him to talk about health care.

Do they think we care but have heard all we want? Health reform has dominated much of the news for almost three years.

Perhaps they feel there is nothing left for them to say. The positions on both sides have been clear for some time, and public opinion had budged very little over the past year or so. What could they add at this point?

And the issue will change dramatically in June when the Supreme Court issues its expected ruling on the law’s constitutionality. Whichever way the decision goes, we will hear plenty about health reform when it is handed down.

However, Obama’s reticence on the issue at this time may turn out to be a mistake. Polls show that much of the public remains confused about the law. Many continue to misunderstand is purpose and effects.

Until health reform is widely understood, broad support for it is unlikely to grow. And public opinion will be crucial in the months ahead. Reactions to the Supreme Court opinion will play a key role in shaping the political environment for Obama’s next steps.

The State of the Union address presented Obama with a prime opportunity to remind Americans of what he has accomplished. The law, if it stands, will guarantee everyone access to health insurance. Americans have never had that assurance before.